Comparison between the 4K ultra-high definition (UHD) and high definition (HD) endoscopic systems for transoral endoscopic thyroidectomy

Abstract

Background: The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is the most recently introduced method of minimally invasive thyroid surgery. To our knowledge, no studies have compared TOETVA outcomes using different laparoscopic systems. This study compared outcomes of TOETVA using conventional high definition (HD) and ultra-high definition (UHD) equipment.

Methods: Medical data and surgery videos of 62 patients who randomized to undergo thyroid lobectomy by TOETVA using an HD or UHD system from August 2018 to April 2019 were retrospectively reviewed. Endoscopic procedures were divided into four phases: flap creation to isthmectomy (phase I); strap muscle division to upper pole ligation (phase II); trimming recurrent laryngeal nerve (phase III); and ligation of Berry's ligament to complete resection (phase IV).

Results: Of the 62 patients, 28 underwent TOETVA using an HD device and 34 using a UHD device. The clinical characteristics of the two groups were not different. Mean operating time for lobectomy was similar in the HD and UHD groups (44.19±9.94 versus 43.47±12.19 min, P=0.825). The times required for phases I (15.02±5.33 versus 13.67±5.44 min, P=0.397); II (12.89±2.84 versus 13.17±5.22 min, P=0.816); III (9.85±4.36 versus 9.98±4.55 min, P=0.918); and IV (6.43±3.69 versus 6.65±3.45 min, P=0.840) were also similar in the HD and UHD groups. The numbers of retrieved lymph nodes did not differ significantly in the HD and UHD groups (3.26±2.62 versus 3.45±2.81, P=0.807).

Conclusions: Applying a UHD system in TOETVA resulted in outcomes similar to those observed with a conventional HD system. Operation time tended to be lower, especially for flap dissection, and numbers of harvest lymph nodes tended to be higher in the UHD group. Large-scale studies are needed to assess the advantages of the UHD system.

Keywords: 4K ultra-high definition camera; endoscopy; high definition camera; thyroid neoplasms; transoral thyroidectomy.

Figure 1

Components of high definition (HD) system. (A) Overall appearance: (a) 26-inch HD display, (b) camera control unit, (c) light source, and (d) HD recorder; (B) close-up of the camera control unit; (C) close-up of an HD endoscope model: (a) HD endoscope, (b) light cable, and (c) HD 3 metal oxide semiconductor (3MOS) chip camera head; (D) light source.

Figure 2

Components of 4K ultra-high definition (UHD) system. (A) Overall appearance: (a) 32-inch UHD medical monitor, (b) UHD all-in-one imaging console, and (c) irrigation pump unit; (B) a UHD all-in-one imaging console with a built-in picture archiving and communication system (PACS): (a) light source, (b) UHD recorder, and (c) camera control unit; (C) a UHD endoscope model: (a) UHD endoscope, (b) light cable, and (c) UHD 3 chip charge coupled device (CCD) camera head; (D) irrigation pump unit.

Figure 3

Operating fields of the HD (A,C,E,G) and UHD (B,D,F,H) systems according to surgical phase. (A) Isthmectomy with the HD system (phase I); (B) isthmectomy with the UHD system (phase I); (C) dissection of the superior pole while saving the left upper parathyroid gland using the HD system (phase II); (D) dissection of the superior pole while saving the left upper parathyroid gland using the UHD system (phase II); (E) identification of the left recurrent laryngeal nerve with the HD system (phase III); (F) identification of the left recurrent laryngeal nerve with the UHD system (phase III); (G) central compartment lymph node dissection in the HD system (phase IV); (H) central compartment lymph node dissection in the UHD system (phase IV). UP, upper parathyroid gland; RLN, recurrent laryngeal nerve; CCN, central compartment lymph nodes.

Figure 4

Operating fields of the HD (A,C) and UHD (B,D) systems after lobectomy (A,B) and at the time of bleeding (C,D). (A) After lobectomy in the HD system; (B) after lobectomy in the UHD system; (C) operation with the HD endoscopic system resulting in a large amount of bleeding, causing a poor visual outcome due to the absorption of red color by dark blood; (D) operation with the UHD system, showing that this system was less affected by red color absorption than the HD system, even if a large amount of bleeding occurred. UP, upper parathyroid gland; RLN, recurrent laryngeal nerve.